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Hybrid and Spanning External Fixation

Learn about the history, biomechanics, optimal techniques, and outcomes of hybrid external fixators. Understand the advantages, complications, and comparison with spanning external fixation for complex fractures. Discover the significance of spanning external fixation in soft tissue management and the potential for hybrid fixation in specific cases.

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Hybrid and Spanning External Fixation

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  1. Hybrid and Spanning External Fixation Wayne Cheng, MD Assistant Professor Department of Orthopaedic Surgery Loma Linda University Medical Center SEP 17, 2006

  2. History • Jean-Francois Malgaigne, 1840 • Malgaigne’s point • Malgaigne’s claw • Clayton Parkhill, 1897 • Bone clamp • Lambotte • Lambotte ext fixator

  3. 1940 to 1970 x

  4. Hybrid External fixator • Soft tissue reaction • Affixing smaller metaphyseal fragm • Cancellous bone • Trampoline effect • Half pins

  5. Biomechanics - stability S = r 4 • Wire diameter • Wire tension • Crossing angle • Distance ring to bone • # of wire • Olive wire • Center bone Optimal = 50% of yield strength (80 – 90 kg)

  6. Location at proximal tibia Tornetta et al, JOT 2000

  7. Knee capsular reflection • 14 MM • 10% Spence Reid, MD

  8. Safe corridors distal tibia Vives JOT 15 (8) 2001

  9. Ankle capsule Superior capsular reflection 21 mm from antmed joint line

  10. Insertion technique

  11. Case example 1

  12. Case example 1 – post op

  13. Case 2

  14. Case example 2

  15. Case 2 - final

  16. Is hybrid any good? • 31 complex proxm tibia fx. • 3.7 year f/u • Functional grading (rasmussen) • 84% good • 12% fair • 3% poor • Complication • 23% pin tract infx. • 1 AKA

  17. Why did hybrid fall out of favor? • High maintenance/malunion/nonunion • Cumbersome/bulky • Pin tract infection • Meticulous insertion/assembly • Fracture through pin sites • expensive

  18. Spanning External fixation + secondary internal fixation

  19. Spanning external fixation

  20. Spanning external fixation

  21. Conclusion • Spanning external fixation is a valuable tool for initial soft tissue management • 2nd stage internal fixation is attractive. • Hybrid external fixation is a tool that may be valuable in selected cases.

  22. THANK Y0U

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